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Review
. 2020 Aug 2;16(8):1841-1850.
doi: 10.1080/21645515.2019.1706930. Epub 2020 Jan 29.

BCG: a vaccine with multiple faces

Marco Antonio Yamazaki-Nakashimada  1 , Alberto Unzueta  2 , Luisa Berenise Gámez-González  3 , Napoleón González-Saldaña  4 , Ricardo U Sorensen  5   6
Affiliations
Review

BCG: a vaccine with multiple faces

Marco Antonio Yamazaki-Nakashimada et al. Hum Vaccin Immunother. .

Abstract

BCG has been recommended because of its efficacy against disseminated and meningeal tuberculosis. The BCG vaccine has other mechanisms of action besides tuberculosis protection, with immunomodulatory properties that are now being discovered. Reports have shown a significant protective effect against leprosy. Randomized controlled trials suggest that BCG vaccine has beneficial heterologous (nonspecific) effects on mortality in some developing countries. BCG immunotherapy is considered the gold standard adjuvant treatment for non-muscle-invasive bladder cancer. BCG vaccine has also been tested as treatment for diabetes and multiple sclerosis. Erythema of the BCG site is recognized as a clinical clue in Kawasaki disease. BCG administration in the immunodeficient patient is associated with local BCG disease (BCGitis) or disseminated BCG disease (BCGosis) with fatal consequences. BCG administration has been associated with the development of autoimmunity. We present a brief review of the diverse facets of the vaccine, with the discovery of its new modes of action providing new perspectives on this old, multifaceted and controversial vaccine.

Keywords: BCG; bladder cancer; diabetes; immunomodulation; multiple sclerosis; tuberculosis.

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Figures

Figure 1.
Figure 1.
The many faces of BCG vaccine.
Figure 2.
Figure 2.
Erythema in BCG in Kawasaki Disease, note the variety of lesions of this useful diagnostic sign.
Figure 3.
Figure 3.
Cutaneous manifestation of disseminated BCG in a SCID patient.
See this image and copyright information in PMC

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